A trend is born

News-Times, The (Danbury, CT), Robert Miller THE NEWS-TIMES

Published 1:00 am, Sunday, November 14, 2004

Take a young woman's nice, healthy eggs.

Add some sperm in a laboratory dish.
When one or two egg become fertilized, implant them inside a body of a 56-year-old woman's body.
Voila! In nine months, you've got twins and a front-page story.
You also have a medical and ethical questions with no easy answers.
Last week, New York City motivational speaker
Aleta St. James
made news when she gave birth to twins three days short of her 57th birthday. She is the oldest American woman to have twins, thought it's a record she may not hold for long. A 59-year-old great-grandmother from Georgia is on schedule to deliver twins next month.
Overall, the oldest American to give birth is Arceli Keh of California, who had a daughter in 1996 when she was 63.
St. James was impregnated with donated eggs fertilized in vitro. Doctors delivered a boy and a girl through Ceasarean section on Tuesday, three days before St. James' 57th birthday.
Because it can happen, this type of thing will happen in the future. Although most women in their 40s or 50s may not want the stress of raising an infant, some do.
"More and more women will be able to do this,'' said Dr.

Ervin Jones
, assistant director of the
Yale Center for Reproductive Medicine
at Yale-
New Haven Hospital
. "But 57 is getting old to have a baby.''
What is a trend is woman getting pregnant much later in their lives. In 1970, one woman in 20 got pregnant after the age of 35. Today, that number is one in five.
Why the change? There are more women today who, wanting to have a career outside the home, put off having children until they've established themselves at work.
Divorce is also a factor. Men and women who get divorced, then get marry later in life may decide they want to have a child with their new spouse. "I think we're going to see a lot more women in the 40s who want to get pregnant,'' said Jones.
Dr.

Gerard Foye
, high-risk pregnancy specialist with
Candlewood Center for Women
's Health in Danbury, said a lot of women just love being pregnant and are happy to re-live the experience in the 30s and 40s. Maybe their 50s.
"Some women consider being pregnant they be the best time of their lives, '' he said. "There's the sense of new life. There's the baby moving inside them, (the sense) of holding a newborn. It is a surprisingly powerful instinct.''
The downside of waiting - for a career, for Mr. Right - is that some women wait too long. When they decide to get pregnant in the 40s, many discover they can't. Hence the need for donated eggs and in vitro fertilization and fertility specialists.
Women in Connecticut also have to deal with age limits imposed by hospitals. At the
University of Connecticut School of Medicine
in Farmington, doctors won't assist in a woman's pregnancy over the age of 50.
"We chose 50 because that's the average age of menopause,'' said Dr.
Donald Maier
, chief of reproductive endocrinology and infertility at
UConn School of Medicine
. "We have very few cases of women who are 45 or older who don't use donated eggs to get pregnant. We rarely have cases of women over 45 years old who want to get pregnant.''
At Yale-New Haven Hospital, the age limit is 55 years old. "But we discourage women over 50 from having babies,'' Jones said.
Doctors and fertility specialists said the purely medical issues involved in the St. James story aren't as complicated as they might first sound.
"A woman's uterus has the ability to sustain a pregnancy for a very long time in her life,'' said Jones. "But women usually stop getting pregnant in the 40s because their ovaries stop producing eggs.''
Enter modern reproductive technology. Fertility clinics can pay young women to provide them with eggs. Because these women are often in their 20s, using those eggs has advantages.
"The genetic issues aren't the same as they are having an older woman's own eggs,'' said Dr.
Kevin Mitchell
, an obstetrician/gynecologist with Candlewood Center for Women's Health. "You don't have to worry about things like (the baby having) Down Syndrome.''
An older mother-to-be has to start getting hormone injections - estrogen and progesterone - to stimulate the uterus and get it ready to receive the egg. The older mother must remain on hormone treatments for the first few months of her pregnancy.
Once a woman is pregnant, there are new issues. The older the woman, the greater the health risk during pregnancy.
"The risk is high for hypertension and diabetes in the mother,'' said Mitchell, of the Candlewood Center for Women's Health. "Obviously, a woman who is 45 years old is at risk.''
As women get older, the blood vessels in the pelvic area can get narrowed by atherosclerosis - the same process that can clog the arteries leading to the heart. That means the uterus, and the fetus, are getting less blood.
Women with poor blood supply to their uterus are at a higher risk for toxemia - a form of hypertension that can cause the placenta to detach from the uterine wall. Their babies can be born prematurely and undersized.
But through medication and careful monitoring, women in their late 40s and 50s can have a healthy baby. In some ways, that's the easy part. The hard part is raising the child.
Caring for a newborn, then a toddler, then a child in school, can wear out a woman in her 20s.
For a woman in her 40s and 50s without the benefit of serious nanny support or lots of available family members to step in, the strain is even harder. They simply don't have the energy they did two decades earlier.
"Do you want to raise a toddler in your 60s and a teenager in your 70s?'' said Foye of the Candlewood Center for Women's Health. "That's hard to do.''
Having a child in your 40s or 50s may also means foregoing any thoughts of early retirement. At 60 or 70, you may be forced to think instead about paying college tuition.
However, physicians say, many women today assume they will live into their late 70s or 80s - long enough to see their child grow into maturity. Those hopes outweigh the risks.
Still, doctors take pains to counsel women who want to get pregnant late in life.
"You have to go over everything to see what their feelings are, to make sure the woman and her significant other are certain they want this baby and will care for it,'' Foye said.
Still, Foye said, sometimes an obstetrician might have enough misgivings to tell a woman to find another doctor. "Doctors have the option to say, ethically, they don't think this is the right thing.'' he said.
For Maier of UConn, cases like St. James' are troubling, simply because they may lead women to think they can postpone getting pregnant until their 40s or 50s without suffering any consequences.
"For a women who is 35 years old to have the idea that she can wait a few more years and it won't make a difference could be a mistake,'' he said. "What a lot of people don't understand is that a woman's chance of getting pregnant seriously declines after she gets over 40.''
It also should make doctors ask this question: Should doctors, and society, encourage a 57-year old woman to have twins?
"Medically, it's possible,'' Maier said "But that doesn't always make it a wise thing to do.''